EP2422827A2 - Implant doté d'une couche de surface dotée d'une modification topographique - Google Patents

Implant doté d'une couche de surface dotée d'une modification topographique Download PDF

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EP2422827A2
EP2422827A2 EP11178588A EP11178588A EP2422827A2 EP 2422827 A2 EP2422827 A2 EP 2422827A2 EP 11178588 A EP11178588 A EP 11178588A EP 11178588 A EP11178588 A EP 11178588A EP 2422827 A2 EP2422827 A2 EP 2422827A2
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Prior art keywords
spreading
cell
implant
cells
gratings
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EP2422827A3 (fr
EP2422827B1 (fr
Inventor
Aldo Ferrari
Vartan Kurtcuoglu
Philipp Schön
Jens Ulmer
Alexander Borck
Matthias Gratz
Alexander Rzany
Robert Schmiedl
Dimos Poulikakos
Björn Klocke
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Biotronik AG
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Biotronik AG
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
    • A61L31/00—Materials for other surgical articles, e.g. stents, stent-grafts, shunts, surgical drapes, guide wires, materials for adhesion prevention, occluding devices, surgical gloves, tissue fixation devices
    • A61L31/14—Materials characterised by their function or physical properties, e.g. injectable or lubricating compositions, shape-memory materials, surface modified materials
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
    • A61L31/00—Materials for other surgical articles, e.g. stents, stent-grafts, shunts, surgical drapes, guide wires, materials for adhesion prevention, occluding devices, surgical gloves, tissue fixation devices
    • A61L31/02—Inorganic materials
    • A61L31/022—Metals or alloys
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
    • A61L31/00—Materials for other surgical articles, e.g. stents, stent-grafts, shunts, surgical drapes, guide wires, materials for adhesion prevention, occluding devices, surgical gloves, tissue fixation devices
    • A61L31/08—Materials for coatings
    • A61L31/10—Macromolecular materials
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
    • A61L2400/00—Materials characterised by their function or physical properties
    • A61L2400/18—Modification of implant surfaces in order to improve biocompatibility, cell growth, fixation of biomolecules, e.g. plasma treatment

Definitions

  • the present invention refers to an implant with a surface layer having a topographic modification.
  • US 2009/0248157 A1 provides a biocompatible substrate for cell adhesion, differentiation, culture and/or growth.
  • the substrate having an arrangement of topographical features arrayed in a pattern based on a notional symmetrical lattice in which the distance between nearest neighbour notional lattice points is C and is between 10 nm and 10 ⁇ m.
  • the topographical features are locally miss-ordered such that the centre of each topographical feature is a distance of up to one half of C from its respective notional lattice point.
  • Cell spreading on a substrate is a highly regulated process that requires the fast interaction between transmembrane receptors of the integrin family and specific ligands on the surface of the substrate ( B. Geiger, J. P. Spatz and A. D. Bershadsky, Nat Rev Mol Cell Biol, 2009, 10, 21-33 ).
  • Early receptor binding leads to onset of spreading and goes along with the enrichment of cytoplasmic proteins at the adhesion site.
  • talin, paxillin, vinculin, and several other proteins contribute to the generation of a nascent focal complex.
  • the recruitment of activated Focal Adhesion Kinase (FAK) and Src-kinase forms the basis of adhesion signalling ( X.
  • FAK Focal Adhesion Kinase
  • Src-kinase forms the basis of adhesion signalling
  • Endothelial cells spread poorly on flat, rigid implant surfaces such as those of commonly used stents for the treatment of the effects of coronary artery disease ( S. Garg and P. W. Serruys, JAm Coll Cardiol, 2010, 56, S1-42 ; M. Hristov, A. Zernecke, E. A. Liehn and C. Weber, Thromb Haemost, 2007, 98, 274-277 ).
  • Topographic modifications of the surface with micron and sub-micron scale structures may accelerate onset of spreading as well as subsequent topography-guided cell polarization (contact guidance), which are requirements for the re-establishment of a differentiated endothelium.
  • an implant with a surface layer having a topographic modification including a line pattern with ridge and groove widths of 0.9 to 1.1 ⁇ m, more preferred 0.95 to 1.05 ⁇ m, especially 1 ⁇ m, and a ridge height of more than 0.9 ⁇ m, especially 1 ⁇ m or more.
  • the topographic modification includes a line pattern (or grating) of characteristic dimension suitable for cell adhesion. Ridge width and groove width should be the same or nearly the same (for example a ratio of 0.9 ⁇ m ridge width to 1.1 ⁇ m groove width should be included). The entire surface or only fractions of the surface of the implant may be covered by the surface layer showing the inventive topographic modification.
  • the implant includes a main body made of a metallic material and the surface layer is disposed on the main body and being made of a polymer material.
  • the manufacturing process of the inventive topographic modification can be simplified for example in that a surface layer of the polymeric material is heated up to its glass transition temperature and a die having a negative contour of the line pattern is pressed into the polymeric material.
  • the metallic material is a biodegradable metallic material.
  • the biodegradable metallic material may be one selected of a magnesium alloy, iron alloy, magnesium or iron.
  • the biodegradable metallic material is a magnesium alloy.
  • a magnesium alloy is to be understood as a metallic structure, the main component of which is magnesium.
  • the main component is the alloy component that has the highest proportion of weight in the alloy.
  • the share of the main component preferably amounts to more than 50% by weight, particularly more than 70%. The same applies to what is understood of the term iron alloy.
  • biodegradable in which degradation occurs in a physiological environment, which finally results in the entire implant or the part of the implant formed by the material losing its mechanical integrity.
  • Artificial plasma as has been previously described according to EN ISO 10993-15:2000 for biodegradation assays (composition NaCl 6.8 g/l. CaCl 2 0.2 g/l. KCl 0.4 g/l. MgSO 4 0.1 g/l. NaHCO 3 2.2 g/l. Na 2 HPO 4 0.126 g/l. NaH 2 PO 4 0.026 g/l), is used as a testing medium for testing the corrosion behavior of a material coming into consideration.
  • a sample of the material to be assayed is stored in a closed sample container with a defined quantity of the testing medium at 37°C.
  • the sample is removed and examined for corrosion traces in a known way.
  • the polymer material of the surface layer may a biodegradable polymer material.
  • biodegradable polymers include polydioxanone, polyglycolide, polycaprolactone, polylactide (for example poly-L-lactide, poly-D,L-lactide and copolymers and blends such as poly(L-lactide-coglycolide), poly(D,L-lactide-coglycolide), poly(L-lactide-co-D,L-lactide), poly(L-lactide-cotrimethylene carbonate), polysaccharides (for example chitosan, levan, hyaluronic acid, heparin, dextran, cellulose), polyhydroxyvalerate, ethylvinyl acetate, polyethylene oxide, polyphosphoryl choline, fibrin, albumin, polyhydroxybutyric acid (atactic, isotactic, syndiotactic and blends thereof), and the like.
  • the line pattern of the surface layer may be covered by a biodegradable topcoat.
  • the topcoat may protect the line pattern as well as a drug eluting coating especially during the process of implantation.
  • an angle between a groove bottom surface and a side wall of the ridge is between 90° to 135°.
  • the line pattern needs not to cover the whole surface of the implant but may be interrupted for example in longitudinal extension of the implant. According to own investigations (cf. Fig. 15 ), this deterioration of microstructures will not have any significant effect on cell orientation and migration until more than 40% of the lines and spacing are missing. At 60% loss of structure integrity cells behave as on flat surfaces.
  • the line pattern is preferably perfect or is deteriorated to less than 40% of the perfect line pattern.
  • the implant may include two or more areas of line pattern, wherein for example the orientation of the line pattern with respect to a longitudinal extension of the implant is different.
  • the line pattern is oriented orthogonal to implant geometry. In case of the implant is a stent, the line pattern is preferably oriented orthogonal to a stent strut direction.
  • Implants are devices introduced into the body via a surgical method and comprise sensors, fasteners for bones, such as screws, plates, or nails, surgical suture material, intestinal clamps, vascular clips, prostheses in the area of the hard and soft tissue, and anchoring elements for electrodes, in particular, of pacemakers or defibrillators.
  • the implant is preferably a stent.
  • Stents are endovascular prostheses which may be used for treatment of stenoses (vascular occlusions). Stents typically have a hollow cylindrical or tubular basic mesh which is open at both of the longitudinal ends of the tubes. The tubular basic mesh of such an endoprosthesis is inserted into the blood vessel to be treated and serves to support the vessel. Stents of typical construction have filigree support structures made of metallic struts which are initially provided in an unexpanded state for introduction into the body and are then widened into an expanded state at the location of application. Preferably, the line pattern covers at least a luminal surface of the stent.
  • cellular mechanosensation is influencing adhesion, proliferation and migration by transducing the external mechanical signals into internal biological stimuli regulating cellular behaviour.
  • the orientation and arrangement of the structural features and the wall shear stress along the strut surface one can significantly enhance and accelerate the wound healing process. Not only circulating progenitor cell adhesion may be enhanced but also proliferation and migration of existing endothelial cells will be influenced and guided by the micro-texture.
  • the stent may be a drug eluting stent (DES).
  • DES drug eluting stent
  • Incorporation of drug eluting stents into a vessel is usually prohibited or inhibited by use of antiproliferative drugs like rapamycin or paclitaxel as a side effect.
  • antiproliferative drugs like rapamycin or paclitaxel as a side effect.
  • formation of a thin neointima appears to be essential for healing of the vessel.
  • the inventive topographic modification the healing process can be supported and accelerated.
  • live-cell imaging and high-resolution microscopy has been applied to measure spreading dynamics and contact guidance on biocompatible structured substrates.
  • the interaction between cells and topography was further resolved using scanning electron microscopy.
  • specific inhibitors of cell contractility to further analyze the role of the ROCK1/2-myosin-II pathway in the regulation of onset of endothelial spreading and contact guidance has been used.
  • biochemical techniques and fluorescent staining to pinpoint the relevant molecular players contributing to this effect have been applied.
  • chromium patterns had to be transferred into a 525 ⁇ m thick silicon wafer via photo lithography and reactive ion etching.
  • the wafer was spin-coated with a Microposit S1805 positive tone photo resist (thickness ⁇ 0.5 ⁇ m).
  • the gratings were imprinted on 180 ⁇ m thick untreated Cyclic Olefin Copolymer (COC) foils (Ibidi, Germany) using nanoimprint lithography (NIL).
  • the height of the ridges was adjusted by tuning the etching time while the side wall steepness was kept constant. This procedure generated squared patterned areas of 1 cm side length.
  • Ten molds were fabricated with ridge and groove widths of 1 ⁇ m and ridge height of 0.1, 0.2, 0.4, 0.6, 0.8, 1, 1.5, and 2 ⁇ m and with ridge and groove width of 5 ⁇ m and ridge height of 0.1 and 1 ⁇ m (Table 1).
  • the COC substrates were placed on top of the mold and softened by raising the temperature up to 160- 180°C. A pressure of 50 bar was then applied for 10 minutes before cooling down to 40°C. Finally, the pressure was released and the mold was detached from the substrate with a scalpel ( Fig. 9 ). Samples were then treated with oxygen plasma (100 W for 30 seconds) to increase the hydrophilicity of the surface and to promote cell adhesion.
  • the water static contact angle of COC before treatment was 94.3° ⁇ 0.4° and was reduced to 27.8° ⁇ 1.3° after treatment.
  • the imprinted gratings were systematically characterized by scanning-electron microscopy before cell culturing ( Fig. 9 ).
  • Fig. 13 is a schematic sectional view of the line pattern according to two embodiments of the invention.
  • the implant body A for example a stent
  • a surface layer B for example a drug eluting polymer layer
  • An angle ⁇ between the bottom of a groove D and a side wall of the ridge C is set to be 90° in the upper embodiment and more than 90° in the lower embodiment.
  • Tab. 1 grating ridge width ( ⁇ m) groove width ( ⁇ m) groove depth ( ⁇ m) FLAT 0 0 0 A-20 1 1 2 A-15 1 1 1.5 A-10 1 1 1 A-8 1 1 1 0.8 A-6 1 1 1 0.6 A-4 1 1 1 0.4 A-2 1 1 0.2 A-1 1 1 0.1 B-10 5 5 1 B-1 5 5 0.1
  • Vinculin-FP635 (Far Red Fluorescent Protein) construct was used (a kind gift of Dr. Ralf Kemkemer, Max Planck Institute for Metals Research, Stuttgart, Germany).
  • Human umbilical vein endothelial cells (HUVEC; Invitrogen) were grown in medium 200PRF supplemented with fetal bovine serum 2% v/v, hydrocortisone 1 ⁇ g/ml, human epidermal growth factor 10 ng/ml, basic fibroblast growth factor 3 ng/ml and heparin 10 ⁇ g/ml (all reagents from Invitrogen) and were maintained at 37°C and 5% CO 2 .
  • HUVEC were transfected using a Neon Transfection System (Invitrogen). All reported experiments were performed using cells with less than seven passages in vitro.
  • 'topographic chip' Up to six imprinted COC substrates (1 cm 2 ) were individually sealed to the bottom of a well in a 12-multiwell culture plate (Becton Dickinson, USA) hereafter denoted as 'topographic chip'.
  • the topographic chips were sterilized by overnight treatment with ethanol and rinsed three times with PBS.
  • the substrates were then coated with Poly-L-lysine (PLL) solution 0.01% (Sigma-Aldrich, USA) according to the manufacturer's specification.
  • PLL Poly-L-lysine
  • cells were seeded on COC substrates at high density (60-70x104 cell/cm 2 ) as reported by Lampugnani et al. and cultured for three days.
  • cells were detached from a subconfluent cell culture and resuspended in pre-warmed medium without antibiotics. The cells were then counted, diluted to reach a concentration of 5x104 cells in 1 ml of medium and then seeded onto the substrates.
  • the cell membrane was labelled using a vital fluorophore (CellTracker Green, C2925 Molecular Probes; Invitrogen).
  • HUVECs were seeded 24 hours before the experiment in a 12 well plate (1x105 cell/well). For staining, cells were washed and incubated for 30 min at 37°C in medium without serum containing 0.5 ⁇ M CellTracker Green. After labeling, complete fresh medium was added and cells were left to recover for 30 minutes before starting the spreading experiment. Cells were gently detached, counted and seeded on the substrate and imaging started immediately after seeding.
  • DMSO corresponding v/v
  • ML-7 corresponding v/v
  • 10 ⁇ M Y27632 10 ⁇ M Y27632
  • 50 ⁇ M blebbistatin 50 ⁇ M blebbistatin.
  • the drugs were dissolved in DMSO (ML-7, blebbistatin) or in distilled water (Y27632) and added to the cells 30 minutes before starting the experiment.
  • PFA paraformaldehyde
  • VE-Cadherin and phosphorylated (p)-FAK in HUVECs were localized following the protocol reported by Lampugnani et al.22 Briefly, cells were fixed for 15 minutes with 3% PFA and then permeabilized for 3 minutes with a solution of 0.1% TritonX-100 in 3% PFA at room temperature. After washing once with PBS, cells were incubated for 1 hour with blocking buffer. Samples were then incubated with primary antibody in blocking buffer overnight. After five washings with 5% BSA in PBS, cells were incubated with secondary antibody for 1 hour. Samples were finally washed three times (1 hour each) in PBS, post-fixed for 2 minutes in 3% PFA and mounted with DAPI-containing Vectashield (Vector Labs Inc., USA).
  • the experiment was started to automatically acquire a dif ferential interference contrast (DIC) image at each saved position with a time resolution of 1 minute for a total of one or two hours. Focal drift during the experiments was eliminated using the microscope's PFS autofocus system. At the end of the experiment, the resulting time-lapses were converted into a single 8 bit movie for each imaging field under analysis.
  • DIC dif ferential interference contrast
  • Fluorescent movies of CellTracker Green-labelled cells were collected at the cell-substrate interface using a 40X, 1.30 NA oil immersion objective (PlanFluor, Nikon) for a total of one or two hours. Images were collected in both DIC and FITC channels with a time resolution of 1 or 2 minutes.
  • Fluorescent images of HUVEC expressing vinculin-FRFP or stained with TRITC-phalloidin,VE-Cadherin, or pFAK antibodies were acquired with a 60X, 1.2 NA water immersion objective (PlanApo, Nikon) using a TRITC or FITC filter.
  • HUVEC alignment to the gratings was measured for all cells detected in the last frame of each recorded movie.
  • the cell profile was manually drawn using the 'Freehand selection' tool of ImageJ.
  • the cell area and the cell orientation angle were then obtained respectively using the 'Area' and the ⁇ Fit ellipse' options in the 'Measurements' tool of ImageJ.
  • the obtained value in degrees was normalized relative to the orientation of the grating extracted from the same image.
  • the range of possible alignment angles between cells and gratings is 0° to 90°. Thus a value close to 0° indicates perfect alignment while a value of 45° indicates no alignment.
  • HUVEC human umbilical vein endothelial cells
  • COC cyclic-olefincopolymer
  • the projected cell surface was recorded during the entire process for individual cells contacting four different grating types (A-10, A-1, B-10, B-1; Table 1) and compared to what was observed on flat substrates.
  • the graph in Fig. 1B reports individual measurements of spreading dynamics for cells contacting different substrates.
  • the projected surface increases after onset of spreading in a process corresponding to rapid cell spreading and eventually reaches a plateau which is then maintained by the cells.
  • the time to onset of spreading varies considerably among cells contacting different substrates ( Fig. 1B ) suggesting that the substrate topography plays a critical role during the early phases of endothelial spreading.
  • Fig. 2A reports the average time to onset of spreading of HUVEC onto four different grating types (A-10, A-1, B-10, B-1; Table 1). Comparison with the average time to onset of spreading on flat substrates reveals that the gratings with the smallest tested lateral periodicity and deepest tested grooves (A-10) accelerates onset of spreading by about 40% ( Fig. 2A ). On all other tested gratings, onset of spreading is disfavored.
  • the cell area was quantified at different times after seeding and compared to what was measured in the case of cells contacting flat substrates ( Fig. 2B ).
  • HUVECs contacting flat substrates show an average projected cell surface of 955 ⁇ 58 ⁇ m 2 .
  • the projected surface of cells seeded on textured substrates ranges from 772 ⁇ 40 ⁇ m 2 for cells on gratings A-1 to 420 ⁇ 21 ⁇ m 2 for cells on gratings B-10.
  • cells on gratings A-1, A-10 and B-1 spread to values comparable to the control within two hours after seeding and maintain similar values at later time points (3 hours, Fig. 2B ).
  • the cells spreading on gratings B-10 are 40% and 30% smaller than control, respectively, indicating that on this specific topography cell spreading is partially impaired ( Fig. 2B ).
  • Anisotropic topographies are known to induce the polarization of adherent cells. 16
  • Contact guidance measures the efficiency of cell-topography-interaction upon spreading. The average cell-to-substrate alignment angles are 6.3 ⁇ 1.3°, 32.5 ⁇ 5°, 18 ⁇ 4.3°, and 34.9 ⁇ 1.3° for substrates A-10, A-1, B-10, and B-1, respectively ( Fig. 2B ). Altogether, these results demonstrate that, to a different extent, endothelial cells polarize along the direction of gratings on all tested patterns. However, contact guidance efficiency is significantly higher on gratings with deeper grooves (A- 10 and B-10).
  • polarization of the cells along a centre line of the structure is not influenced by the groove depth ( Fig. 11 ).
  • a groove depth of at least 1 ⁇ m is preferred and deeper structures do not have any significant influence on cell polarization.
  • Fig. 14 the solid lines represents the radial distribution of the velocity vector of cells located at the downstream edge of the wound and the dashed lines the radial distribution of the velocity vector of cells located on the upstream edge of the wound.
  • Fig. 12 furthermore shows that the relative orientation of line structures, blood flow and wound have a significant impact on wound healing velocity.
  • the highest wound healing velocity is obtained with a wound aligned orthogonal to the direction of blood flow and line structures aligned orthogonal to the wound. Nevertheless a comparable wound healing velocity is obtained in the situation where the wound is aligned parallel to the direction of blood flow and the line structures are aligned orthogonal to the wound. What must be avoided is the situation where wound and line structures are parallel to each other.
  • Optimal in-growth, i.e. endothelialisation of implants is therefore obtained when implant geometry and line structures are orientated orthogonal to each other.
  • a technical solution for stent implants would be to align the line structure orthogonal to the direction of the struts at each point of the stent body. This can be for example easily achieved by a structuring tool adapted to the specific stent design.
  • the graph in Figure 3B reports the temporal evolution of average projected surface for cells contacting flat substrates or gratings A-10.
  • HUVECs on gratings A-10 initiate spreading on average 8 ⁇ 2 minutes after seeding. In this condition, the projected cell surface increases 4.2 fold within 30-35 minutes after seeding and is then maintained for the rest of the recording.
  • cells contacting a flat substrate initiate spreading 24 ⁇ 2 minutes after seeding and experience a five-fold increase of their projected cell surface within 65 minutes after seeding.
  • 3C reports the corresponding circularity for cells spreading on gratings A-10 or on flat substrates.
  • cells on both substrates Prior to onset of spreading, cells on both substrates show similar shape and display circularity close to 1.
  • the interaction with gratings A-10 induces a dramatic cell-shape change immediately after onset of spreading.
  • the circularity rapidly drops to a plateau close to 0.5 which is then maintained after full spreading.
  • the vinculin-rich adhesions are visibly elongated along the gratings and confined to ridges ( Fig. 5C ). Owing to the resulting geometrical constraint, only adhesions growing along the grating direction are able to mature, while the maturation of adhesions growing in other directions is limited by the grooves ( Fig. 5E ). In addition, the size of adhesions established by cells on gratings A-10 is significantly larger (2.3 ⁇ 0.1 ⁇ m 2 ; Figs. 5 D-E ) than on control flat substrates (1.8 ⁇ 0.1 ⁇ m 2 ), indicating that confinement onto ridges promotes the maturation of aligned adhesions.
  • Adhesion maturation requires forces generated by the cell and the mechanical linkage between the actin cytoskeleton and the adhesion site, which are established after the onset of spreading. Hence, the question is whether the measured effect on FA maturation ( Fig. 5 ) is necessary to accelerate the onset of spreading and/or enhance contact guidance on gratings A-10 ( Figs. 2-4 ).
  • the resulting model paves the way to an improved design of cardiovascular implants yielding a faster and more efficient re-endothelialization.

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  • Health & Medical Sciences (AREA)
  • Epidemiology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Surgery (AREA)
  • Vascular Medicine (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Inorganic Chemistry (AREA)
  • Chemical & Material Sciences (AREA)
  • Prostheses (AREA)
  • Materials For Medical Uses (AREA)
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EP2338534A2 (fr) * 2009-12-21 2011-06-29 Biotronik VI Patent AG Implant médical, procédé de revêtement et procédé d'implantation
US9629713B2 (en) * 2011-09-15 2017-04-25 Cornell University Biomedical implant for use in fluid shear stress environments
US10709821B2 (en) 2014-11-24 2020-07-14 Biotronik Ag Sealing structure for heart valve implants
US10435734B2 (en) 2015-03-09 2019-10-08 University Of Washington Micro- and nanopatterned substrates for cell migration and uses thereof
US11058564B2 (en) 2019-02-27 2021-07-13 Vactronix Scientific Llc Stent and method of making same

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X. ZHANG, G. JIANG, Y. CAI, S. J. MONKLEY, D. R. CRITCHLEY, M. P. SHEETZ, NAT CELL BIOL, 2008

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